Kruchość chorych kierowanych na operacje kardiochirurgiczne — badanie pilotażowe

Introduction. Frailty has been recently approved in many surgical fields as the acknowledged preoperative predictor of adverse postoperative complications. Several methods are available to assess frailty assessment which focus on different patient-related data. The aims of the study were: 1) to verify whether frailty may predict early postoperative complications in cardiac surgery; and 2) to investigate the agreement between objective and subjective assessment of frailty. Material and methods. This prospective study included 54 consecutive patients (32 men; median age 75 years) hospitalized between December 2015 and February 2016. Frailty was assessed using the Edmonton Frail Scale (EFS, subjective tool) and the Modified Frailty Index (MFI, objective tool). Complications were evaluated based on medical records. Results. The median EFS was 6 (IQR 5–7) points. Frailty was observed in 15% and vulnerability in 49% of subjects. The median MFI was 0.45 (IQR 0.36–0.56). We found a weak correlation between frailty and the length of hospital stay (EFS: r = 0.22; P = 0.1; MFI: r = 0.324; P = 0.02). Neither tools could predict the occurrence of postoperative complications (EFS: AUROC = 0.602; 95% CI 0.459–0.732; P = 0.2; MFI: AUROC = 0.532; 95% CI 0.389–0.670; P = 0.2). We found no correlation between EFS and MFI (r = 0.05, P = 0.7). Conclusions. Although many elderly cardiac surgical patients are at risk of frailty, none of the evaluated methods could predict postoperative complications. Available diagnostic tools to assess frailty cannot be used interchangeably. Subjective assessment (by a patient) should be verified by objective evaluation (by a treating physician) and conclusions should be drawn based on the overall clinical picture

Short- and long-term outcomes of continuous-flow left ventricular assist device therapy in 79 patients with end-stage heart failure

Introduction An increasing number of patients with end‑stage heart failure, along with a shortage of heart donors, necessitates the use of mechanical circulatory support. Objecti ves This single‑center retrospective study evaluated short- and long‑term outcomes of continuous‑flow left ventricular assist device (CF‑LVAD) therapy in patients with end‑stage heart failure. Patient s and methods We collected and assessed data of 79 patients (77 men, 2 women; mean age, 50.3 years; mean INTERMACS profile, 3.1) implanted with a CF‑LVAD between 2009 and 2017 (HeartMate 3 in 19 patients [24%]; HeartMate 2 in 9 [11.4%]; and HeartWare in 51 [64.6%]). Result s The mean time on CF‑LVAD support was 604 days (range, 1–1758 days). There were 2 device exchanges due to pump thrombosis and 1 explantation due to heart regeneration; 9 patients (11.4%) underwent heart transplant. Stroke (nondisabling, 48%) occurred in 27.8% of patients (ischemic in 9 patients; hemorrhagic, in 14; both types, in 1) despite the standardized anticoagulation regimen. Major gastrointestinal bleeding and pump thrombosis were reported in 13 patients (16.5%), while 18 patients (22.8%) developed driveline infections (recurrent in 15 patients [19%]). Hemorrhagic stroke and bacteremia had a negative impact on survival. Hemorrhagic stroke was the main cause of death. Survival probability was 0.9 at 1 month and 0.81, 0.71, 0.61, and 0.53 at 1, 2, 3, and 4 years, respectively. Conclusions Although CF‑LVAD support is associated with substantial adverse events, they do not significantly affect mortality (except hemorrhagic stroke and bacteremia). Novel devices seem to overcome these limitations, but larger studies are needed to support these findings

Mechanical circulatory support restores eligibility for heart transplant in patients with significant pulmonary hypertension

Background: An increasing number of patients with end‑stage heart failure implies a wider use of left ventricular assist devices (LVADs). Irreversible pulmonary hypertension (PH) is a predictor of unfavorable prognosis and a contraindication to orthotopic heart transplant (OHT). Aims: The aim of this study was to evaluate the effect of continuous‑flow LVAD (CF‑LVAD) support on pulmonary pressure and pulmonary vascular resistance (PVR) as well as the impact of pre‑LVAD hemodynamic parameters on survival during LVAD support. Methods: Data collected from 106 patients who underwent CF‑LVAD implantation in the years 2009 to 2018 (men, 95.3%; mean [SD] age, 51.8 [12] years; mean [SD] INTERMACS profile, 2.9 [1.6]; mean [SD] LVAD support time, 661 [520] days; follow‑up until May 2019) were retrospectively analyzed. Results: Right heart catheterization was performed before LVAD implantation in 94 patients (88.7%), after implantation—in 31 (29.2%), and before and after implantation—in 28 (26.4%). We observed mean pulmonary artery pressure (mPAP) > 25 mm Hg in 65 patients (61.3%) and PVR > 2.5 Wood units in 33 patients (31.1%) before LVAD implantation. A significant improvement after CF‑LVAD implantation was noted in mPAP, pulmonary capillary wedge pressure, transpulmonary gradient, PVR, cardiac output (P < 0.001 for all parameters), and cardiac index (P = 0.003). All patients with initially irreversible PH became eligible for OHT during LVAD support. Survival during LVAD support did not depend on initial mPAP and PVR. Conclusions: In patients with end‑stage heart failure, CF‑LVAD support leads to a significant reduction of pre‑ and postcapillary PH. Survival on CF‑LVAD support is independent of elevated mPAP and PVR before implantation, which suggests that LVADs decrease the risk associated with PH

Off-pump versus on-pump coronary artery surgery in octogenarians (from the KROK Registry)

BackgroundAccording to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians.ObjectivesThe aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data.MethodsAll octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery.ResultsOctogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013).ConclusionOn the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians